Erythromycin reduces delayed gastric emptying in critically ill trauma patients: A randomized, controlled trial

被引:65
作者
Berne, JD
Norwood, SH
McAuley, CE
Vallina, VL
Villareal, D
Weston, J
McClarty, J
机构
[1] E Texas Med Ctr, Div Trauma Serv, Tyler, TX USA
[2] Univ Texas Hlth Ctr, Tyler, TX 75710 USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2002年 / 53卷 / 03期
关键词
erythromycin; trauma; traumatic injury; delayed gastric emptying; intragastric feeding; gastric motility;
D O I
10.1097/00005373-200209000-00004
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Early enteral feeding has been shown to be beneficial in improving outcome in critically injured trauma patients. Delayed gastric emptying occurs frequently in trauma patients, increasing the time to achieve nutritional goals, and limiting the benefit of early enteral feedings. Intravenous erythromycin is an effective agent for improving gastric motility in diabetics and postgastrectomy patients. The purpose of this study is to determine the effectiveness of erythromycin for improving gastric motility in critically injured trauma patients. Methods: All critically injured patients who received gastric feedings within 72 hours of admission were candidates for the study. Those patients who failed to tolerate feedings at 48 hours (gastric residual > 150 mL) were eligible for enrollment. Patients were prospectively assigned to two treatment groups by randomization to receive either erythromycin (ERY) or placebo (PLA). Treatment was continued in patients who tolerated gastric feedings until the feedings were no longer required. Patients with continued intolerance for 48 hours after randomization were considered failures of therapy and given metoclopramide. Results: Sixty-eight patients were enrolled and were well matched for age, sex, and Injury Severity Score. Mortality, intensive care unit length of stay, hospital length of stay, number of ventilator days, and rate of nosocomial infections were similar in each group. There was a significant difference between the ERY group and the PLA group in the amount of feedings tolerated at 48 hours (58% vs. 44%,p = 0.001). There was no difference in the amount of feedings tolerated (as a percentage of target goal volume) throughout the entire duration of the study (ERY [65% of target] vs. PLA [59%], p = 0.061). Overall success of therapy at 48 hours was 56% in the ERY group versus 39% in the PLA group, but this also did not reach statistical significance (p 0.22). Conclusion: Intravenous erythromycin improves gastric motility and enhances early nutritional intake in critically injured patients.
引用
收藏
页码:422 / 425
页数:4
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